我国钢铁厂噪声与高血压发病风险关系的Meta分析

目的 探讨钢铁厂工人噪声暴露与高血压发病风险的关系。方法 使用计算机联机检索国内外数据库,通过关键词收集相关研究文献,提取数据后使用Stata 12.0软件进行Meta分析。结果 共检索到3 392篇相关文献,经筛选后纳入12篇文献,涉及我国6个地区。使用随机效应模型对各组效应量进行合并,钢铁厂暴露噪声组高血压的发病风险是未暴露组的2.09倍（OR=2.09,95%CI:1.68~2.60）。其中当噪声暴露量为<85 dB（A）时合并OR为1.24（95%CI:0.60~2.54）,85~dB（A）时合并OR为1.74（95%CI:1.27~2.37）,95~dB（A）时合并OR为3.38（95%CI:2.61~4.37）,≥ 105 dB（A）时合并OR为5.51（95%CI:3.84~7.90）。剂量-反应关系结果表明当钢铁厂噪声增加时,高血压发病风险随之增加。经敏感性分析及发表偏倚检验,Meta分析结果稳定。结论 钢铁厂噪声可能使我国职业工人血压升高,且患高血压的危险性随噪声暴露等级增高而逐渐增加。     

胶质瘤发病风险与手机使用的系统评价

目的评价胶质瘤与手机使用危险性的联系。方法计算机检索MEDLINE、Web of Science、EMBASE、EBSCO、Cochrane Library、ScienceDirect数据库;收集胶质瘤与手机使用相关的病例对照研究文献,检索时间2000-2011年,采用RevMan5.1进行Meta分析。结果 8篇病例对照研究文献纳入,规律使用手机未见有胶质瘤危险性增高;而长期使用手机10年以上者与胶质瘤发生存在联系,OR=1.24(95%CI=1.10~1.40),长期同侧使用手机发生胶质瘤危险性增加58%,OR=1.58(95%CI=1.30~1.94)。结论规律使用手机并不增高胶质瘤的发生风险,长期频繁使用手机可能增加胶质瘤发生的风险,但分析中的偏倚与混杂因子可能影响因果关系的解释。     

幽门螺杆菌感染与胃癌不同关联强度的循证分析

[目的]综合分析幽门螺杆菌(Helicobacter pylori,Hpylori)感染与胃癌的关系. [方法]计算机检索1995年1月～2006年12月CNKI中国期刊、维普中文科技期刊全文数据库、OVID、PubMed外文期刊数据库,纳入Hp感染与胃癌关系的病例对照研究,用Meta分析方法其定量综合分析,估计合并OR值及其95%可信区间(95%CI).[结果]纳入的20个研究存在异质性,采用RevMan 4.2分析软件选择随机效应模型(D-L法)进行Meta分析,OR合并=2.35,OR合并95%CI(1.64,3.36).并将纳入的研究按对照来源、胃癌的部位、检测Hp感染的方法及胃癌病例来自高低发区对其进行亚组分析,探讨各研究结果不一致的原因. [结论]Hp感染与胃癌相关,各研究结果不一致的原因主要与胃癌的部位、对照的类型和胃癌病例来自高发区还是低发区有关. 例对照研究,用Meta分析方法其定量综合分析,估计合并OR值及其95%可信区间(95%CI).[结果]纳入的20个研究存在异质性,采用RevMan 4.2分析软件选择随机效应模型(D-L法)进行Meta分析,OR合并=2.35,OR合并95%CI( .64,3.36).并将纳入的研究按对照来源、胃癌的部位、检测Hp感染的方法及胃癌病例来自高低发区对其进行亚组分析,探讨各研究结果不一致的原因. [结论]Hp感染与胃癌相关,各研究结果不一致的原因主要与胃癌的部位、对照的类型和胃癌病     

吸烟与肝癌关系的Meta分析

[目的]采用Meta分析法探讨吸烟与肝癌发病的相关性,为进行人群健康教育和预防决策提供依据。[方法]以肝癌组与对照组人群是否吸烟的OR值为效应指标,根据一致性检验的结果,选择随机效应模型对OR值进行合并并进行偏倚评估。采用GLS法检验吸烟量与OR值的剂量反应关系。[结果]共查到符合要求的国内外文献50篇,病例和对照数分别为10228、22312例。经异质性检验,50项研究结果存在异质性(q=267.75,P﹤0.0001),经过随机效应模型估计,以不吸烟人群为参比组,吸烟人群患肝癌的合并OR值为1.43(95%CI1.25～1.63)。按地域(亚洲、中北美洲、欧洲)合并OR值(95%CI)分别为1.46(1.24～1.72)、1.65(1.29～2.10)和1.14(0.83～1.57),按国别(国内、国外)合并OR值(95%CI)为1.32(1.07～1.63)和1.51(1.28～1.78),按对照选取的人群(正常人、非肝癌病人)合并OR值(95%CI)为1.41(1.21～1.64)和1.44(1.18～1.75),按研究设计的类型(病例对照、巢式病例对照)合并OR值(95%CI)为1.47(1.29～1.68)和1.00(0.54～1.82),OR值较一致。随吸烟量增加,肝癌发生风险在增加,呈现显著剂量反应关系(Z=4.76,P﹤0.0001)。[结论]吸烟是肝癌发病的危险因素。     

中国人群BMI与肺癌发病风险的Meta分析

目的：探讨肥胖与中国人群肺癌发病风险的关系,分析BMI与肺癌发病风险的剂量-反应关系。方法系统性检索国内外公开发表的有关中国人群BMI与肺癌发病关系的文献,并辅以文献追溯等方法,检索数据库包括中国知网、万方数据知识服务平台、PubMed、Embase和Google Scholar,时间范围从各数据库建库至2014年9月,共检索到93篇文献。采用Meta分析方法计算肥胖与肺癌发病风险的合并OR（95%CI）值,运用广义最小二乘估计方法（GLST）估计BMI与肺癌发病风险的剂量-反应关系。结果最终纳入文献7篇,纳入肺癌病例2351例。Meta分析结果表明,肥胖与肺癌发病风险呈负相关（OR=0.68,95%CI：0.59～0.79）,并且这种负相关不受研究类型、性别、吸烟状况、BMI获取方式和病例来源的影响,异质性检验结果I2=0,P=0.594。BMI与肺癌发病风险呈线性剂量-反应关系,BMI每增加5 kg/m2,肺癌发病风险降低21%（OR=0.79,95%CI：0.71～0.89）,异质性检验结果q=22.43,P=0.002。结论 BMI较高是中国人群肺癌发病的一个保护性因素,由于吸烟是肺癌最重要的危险因素,可能有一定的混杂作用。     

大豆食品摄入与乳腺癌发病关系的Meta分析

目的探讨大豆食品摄入与乳腺癌发病的关系。方法检索1991年到2011年4月公开发表的关于大豆食品摄入与乳腺癌关系的流行病学研究进行Meta分析,结果报告合并比值比(OR)及95%可信区间(95%CI)。结果 28个研究纳入Meta分析,其中有23个病例对照研究,5个队列研究。总体分析,大豆食品摄入对乳腺癌具有保护作用(合并OR=0.86,95%CI 0.78～0.94),但按设计类型分层后,只有病例对照研究的结果显示大豆食品对乳腺癌具有保护作用(合并OR=0.86,95%CI 0.77～0.95)。在不同国家和地区人群中开展的研究结果显示,在亚洲地区人群中,合并OR=0.76(95%CI 0.67～0.87),而欧美地区人群的研究合并OR=1.01(95%CI 0.93～1.09)。对在亚洲地区人群中开展的病例对照研究和队列研究分别进行合并分析,结果显示大豆食品摄入对乳腺癌均具有保护作用,合并OR分别为0.76(95%CI 0.65～0.89)和0.81(95%CI 0.70～0.92)。但在欧美地区人群中开展的两类研究均未发现大豆食品摄入对乳腺癌有保护作用。根据绝经前后的亚组分析结果显示,仅在绝经后女性中大豆食品摄入对乳腺癌起保护作用。结论根据亚洲地区人群中开展的研究,尤其是病例对照研究结果的合并分析,提示大豆食品摄入对亚洲地区女性乳腺癌具有保护作用。     

X线修复交叉互补基因1399位点多态性与肝细胞癌关系的Meta分析

目的探讨X线修复交叉互补基因1(XRCC1)399位点多态性与肝细胞癌发病风险之间的关系。方法检索国内外数据库,获得有关XRCC1基因多态性与肝细胞癌发病风险的病例-对照研究资料,用Review Manager 4.2.8分析软件对纳入本项Meta分析的各研究数据进行综合统计处理及异质性检验,计算合并的OR值(95%CI)。结果符合纳入标准的共有7篇文献。累计肝细胞癌病例1133例,对照1747例。Meta分析结果显示,与野生基因型Arg/Arg相比,杂合变异基因型Arg/Gln和(Arg/Gln+Gln/Gln)合并的OR值(95%CI)均为1.00(0.68,1.47),纯合变异基因型Gln/Gln合并的OR值(95%CI)为1.02(0.60,1.72)。XRCC1 399位点多态性与肝细胞癌的发病风险之间的关系均无统计学意义。结论未发现XRCC1 399位点多态性与肝细胞癌发病风险之间的统计学相关性。     

XRCC1多态性与甲状腺癌易感性关系的Meta分析

摘要:目的　探讨X线修复交叉互补基因（XRCC1）与甲状腺癌易感性的关系。 方法　通过检索数据库,收集XRCC1多态性与甲状腺癌易感性相关的病例对照研究,对研究结果进行Meta分析。通过异质性检验选择固定效应模型或随机效应模型计算合并的比值比（OR值）及其95%置信区间（95%CI）,并进行敏感性分析和发表偏倚评估。 结果　本研究共纳入9篇文献（病例1 909例,对照2 891例）。XRCC1 Arg399Gln多态性与甲状腺癌无关（等位基因对比Arg vs. Gln:OR＝1.11,95%CI＝0.97～1.26）;XRCC1 Arg194Trp多态性与甲状腺癌无关（等位基因对比Arg vs. Trp:OR＝1.08,95%CI＝0.74～1.58）;XRCC1 Arg280His多态性与甲状腺癌无关（等位基因对比Arg vs. His:OR＝1.03,95%CI＝0.75～1.43）。亚组分析中,XRCC1多态性与美洲人群甲状腺癌易感性有关联（Arg399Gln等位基因对比OR＝0.70,95%CI＝0.56～0.89;Arg194Trp等位基因对比OR＝1.49,95%CI＝1.02～2.17）,XRCC1多态性与高加索人群甲状腺癌易感性有关联（隐性模型:OR＝1.43,95%CI＝1.10～2.00）。 结论　XRCC1基因多态性与甲状腺癌的易感性无明显关联。但在美洲人群和高加索人群中,XRCC1多态性和甲状腺癌的易感性相关。     

肾上腺素能β3受体Trp64Arg基因多态性与中国人群高血压病关系的Meta分析

摘要:目的　综合评价肾上腺素能β3受体（beta 3-adrenergic receptor,β3-AR）Trp64Arg 基因多态性与中国人群EH的关系。方法　检索2013年9月以前5个中、英文电子数据库中有关β3-AR Trp64Arg 基因多态性与中国人群EH关系的病例-对照研究,采用比值比（Odds Ratios,OR）和95%可信区间（Confidence Interval,CI）评价β3-AR Trp64Arg 基因多态性与EH易感性的关系。结果　共纳入文献12篇,累计病例组3 065例,对照组2 081例;异质性检验各研究间无明显异质性;Meta分析结果表明,EH组与对照组显性模型OR＝1.203（95%CI:1.056～1.370,P＝0.005）;EH组与对照组等位基因模型OR＝1.174（95%CI:1.047～1.316,P＝0.006）。敏感性分析采用亚组分析法,亚组分析结果显示阳性结论出现在不符合HWE亚组和小样本量研究亚组中。Begg’s漏斗图和Egger’s检验未见明显发表偏倚。结论　β3-AR Trp64Arg基因多态性增加中国人群EH易感性。     

孕期吸烟与先天性腹裂胎儿关系的Meta分析

[目的]探讨孕期吸烟与先天性腹裂胎儿的关系,分析不同孕期和每天不同吸烟量对先天性腹裂的影响。[方法]分别检索6个中英文文献数据库,选择6篇符合纳入标准的文献,通过Review Manager 4.2和Stata软件进行Meta分析。[结果]孕期吸烟与先天性腹裂胎儿之间的合并效应值为OR=2.36（95%CI：2.02～2.76）;每天吸烟量为10～20支及〉20支的合并效应值分别为OR=2.29（95%CI：1.89～2.77）和OR=2.54（95%CI：1.68～3.85）,吸烟量〈10支的无统计学意义;孕期前三个月吸烟的合并效应值为OR=2.46（95%CI：1.52～3.98）。[结论]孕期吸烟尤其孕期前三个月吸烟与先天性腹裂胎儿具有显著相关性,此相关性随每天吸烟量的增加而增大。     

Long-term mobile phone use and brain tumor risk

Handheld mobile phones were introduced in Sweden during the late 1980s. The purpose of this population-based, case-control study was to test the hypothesis that long-term mobile phone use increases the risk of brain tumors. The authors identified all cases aged 20-69 years who were diagnosed with glioma or meningioma during 2000-2002 in certain parts of Sweden. Randomly selected controls were stratified on age, gender, and residential area. Detailed information about mobile phone use was collected from 371 (74%) glioma and 273 (85%) meningioma cases and 674 (71%) controls. For regular mobile phone use, the odds ratio was 0.8 (95% confidence interval: 0.6, 1.0) for glioma and 0.7 (95% confidence interval: 0.5, 0.9) for meningioma. Similar results were found for more than 10 years' duration of mobile phone use. No risk increase was found for ipsilateral phone use for tumors located in the temporal and parietal lobes. Furthermore, the odds ratio did not increase, regardless of tumor histology, type of phone, and amount of use. This study includes a large number of long-term mobile phone users, and the authors conclude that the data do not support the hypothesis that mobile phone use is related to an increased risk of glioma or meningioma.     

The INTERPHONE study: design, epidemiological methods, and description of the study population

The very rapid worldwide increase in mobile phone use in the last decade has generated considerable interest in the possible health effects of exposure to radio frequency (RF) fields. A multinational case–control study, INTERPHONE, was set-up to investigate whether mobile phone use increases the risk of cancer and, more specifically, whether the RF fields emitted by mobile phones are carcinogenic. The study focused on tumours arising in the tissues most exposed to RF fields from mobile phones: glioma, meningioma, acoustic neurinoma and parotid gland tumours. In addition to a detailed history of mobile phone use, information was collected on a number of known and potential risk factors for these tumours. The study was conducted in 13 countries. Australia, Canada, Denmark, Finland, France, Germany, Israel, Italy, Japan, New Zealand, Norway, Sweden, and the UK using a common core protocol. This paper describes the study design and methods and the main characteristics of the study population. INTERPHONE is the largest case–control study to date investigating risks related to mobile phone use and to other potential risk factors for the tumours of interest and includes 2,765 glioma, 2,425 meningioma, 1,121 acoustic neurinoma, 109 malignant parotid gland tumour cases and 7,658 controls. Particular attention was paid to estimating the amount and direction of potential recall and participation biases and their impact on the study results. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users. Baruch Modan is deceased.     

Childhood brain tumour risk and its association with wireless phones: a commentary

Case-control studies on adults point to an increased risk of brain tumours (glioma and acoustic neuroma) associated with the long-term use of mobile phones. Recently, the first study on mobile phone use and the risk of brain tumours in children and adolescents, CEFALO, was published. It has been claimed that this relatively small study yielded reassuring results of no increased risk. We do not agree. We consider that the data contain several indications of increased risk, despite low exposure, short latency period, and limitations in the study design, analyses and interpretation. The information certainly cannot be used as reassuring evidence against an association, for reasons that we discuss in this commentary.     

Long-term use of cellular phones and brain tumours: increased risk associated with use for > or =10 years

Aim

To evaluate brain tumour risk among long‐term users of cellular telephones.

Methods

Two cohort studies and 16 case–control studies on this topic were identified. Data were scrutinised for use of mobile phone for ⩾10 years and ipsilateral exposure if presented.

Results

The cohort study was of limited value due to methodological shortcomings in the study. Of the 16 case–control studies, 11 gave results for ⩾10 years'' use or latency period. Most of these results were based on low numbers. An association with acoustic neuroma was found in four studies in the group with at least 10 years'' use of a mobile phone. No risk was found in one study, but the tumour size was significantly larger among users. Six studies gave results for malignant brain tumours in that latency group. All gave increased odd ratios (OR), especially for ipsilateral exposure. In a meta‐analysis, ipsilateral cell phone use for acoustic neuroma was OR = 2.4 (95% CI 1.1 to 5.3) and OR = 2.0, (1.2 to 3.4) for glioma using a tumour latency period of ⩾10 years.

Conclusions

Results from present studies on use of mobile phones for ⩾10 years give a consistent pattern of increased risk for acoustic neuroma and glioma. The risk is highest for ipsilateral exposure.     

Comparison of measuring instruments for radiofrequency radiation from mobile telephones in epidemiological studies: implications for exposure assessment

The debate on mobile telephone safety continues. Most epidemiological studies investigating health effects of radiofrequency (RF) radiation emitted by mobile phone handsets have been criticised for poor exposure assessment. Most of these studies relied on the historical reconstruction of participants' phone use by questionnaires. Such exposure assessment methods are prone to recall bias resulting in misclassification that may lead to conflicting conclusions. Although there have been some studies using software-modified phones (SMP) for exposure assessment in the literature, until now there is no published work on the use of hardware modified phones (HMPs) or RF dosimeters for studies of mobile phones and health outcomes. We reviewed existing literature on mobile phone epidemiology with particular attention to exposure assessment methods used. Owing to the inherent limitations of these assessment methods, we suggest that the use of HMPs may show promise for more accurate exposure assessment of RF radiation from mobile phones.     

某市市级医院医务人员手机带菌状况与影响因素研究

目的为了解某市市级医院医务人员手机使用及其表面带菌状况,探讨手机使用行为和带菌状况的影响因素。方法2016年4—6月对某市24所市级医院中111名医务人员进行问卷调查、现场观察及手机表面采样。结果共发放并回收有效问卷111份,回收率及有效率均为100.00%。调查对象平均年龄为(32.00±9.03)岁,以女性和护士为主。调查对象中95.50%使用触屏手机,24.32%的医务人员诊疗时有使用手机的现象,65.77%的医务人员每天手机使用时间2 h,93.69%对手机进行过清洁消毒。98.20%医务人员认为手机表面存在病原微生物。共采集111份手机表面样本,合格率80.18%,污染率95.50%,平均菌落数为2.90 CFU/cm~2,最大细菌含量为111.60 CFU/cm~2。44份手机样本表面共检出18种55株致病菌或条件致病菌。年龄、性别、职业是手机使用行为和对手机认知态度的影响因素。性别、职业、手机使用持续时间的手机表面合格率分别比较,差异均有统计学意义(均P0.05);年龄、性别、职业、手机使用持续时间、是否使用手机壳/套的手机表面细菌染菌量分别比较,差异均具有统计学意义(均P0.05)。结论手机表面存在的潜在致病菌可能会通过医务人员诊疗过程中使用手机的行为引发医院感染。     

Use of mobile phones by medical staff at Queen Elizabeth Hospital, Barbados: evidence for both benefit and harm

All members of medical staff, including students, were asked to participate in a self-administered questionnaire concerning patterns of mobile phone use and care. Participants' phones were cultured for micro-organisms. Healthcare professionals working in close proximity to sensitive equipment were surveyed concerning adverse events associated with mobile phones. Telephone operators were asked to monitor time elapsed as they attempted to contact medical staff by various methods. Of 266 medical staff and students at the time of the study, 116 completed questionnaires (response rate=44%). Almost all (98%) used mobile phones: 67% used their mobile phones for hospital-related matters; 47% reported using their phone while attending patients. Only 3% reported washing their hands after use and 53% reported never cleaning their phone. In total, 101 mobile phones were cultured for micro-organisms; 45% were culture-positive and 15% grew Gram-negative pathogens. The survey of staff working in close proximity to sensitive equipment revealed only one report of minor interference with life-saving equipment. Telephone operators were able to contact medical staff within 2min most easily by mobile phone. Mobile phones were used widely by staff and were considered by most participants as a more efficient means of communication. However, microbial contamination is a risk associated with the infrequent cleaning of phones. Hospitals should develop policies to address the hygiene of mobile phones.